Intshayelelo
I-Achalasia ye-cardia (AC) yisifo esibangelwa kukungasebenzi kakuhle kwentliziyo.isifo sokuqala sokuhamba komlomo.Ngenxa yokungaphumli kakuhle kwe-sphincter esezantsi ye-esophageal (LES) kunye nokungabikho kwe-esophageal peristalsis, ukugcinwa kokutya kubangela ukubaI-dysphagia kunye nokusabela. Iimpawu zonyango ezifana nokopha, iintlungu zesifuba kunye nokwehla kobunzima.Ukwanda kwayo kumalunga nama-32.58/100,000.
IunyangoI-achalasia ibandakanya ikakhulu unyango olungelulo utyando, unyango lokwandisa kunye nonyango lotyando.
01 Unyango lwezonyango
Indlela yonyango lwamayeza kukunciphisa uxinzelelo lwe-LES kwixesha elifutshane.Akukho bungqina bucacileyo bokuba amayeza anokuphucula rhoqo nangokusebenzayo iimpawu ze-AC.Amayeza asetyenziswa kakhulu ngoku aquka i-nitrates, i-calcium channel blockers, kunye ne-β-receptor agonists.
(1)IiNitrates, njenge-nitroglycerin, i-amyl nitrate, kunye ne-isosorbide dinitrate
(2)Izithinteli zemijelo yecalcium, njenge-nifedipine, i-verapamil, kunye ne-diltiazem
(3)ii-agonists ze-β-receptor, njenge-cabuterol
02I-Endoscopic Botulinum Toxin Injection (BTI)
I-Endoscopic botulinum toxin injection (BTl) ingasetyenziselwa ukunyanga i-AC,kodwa inokubonelela ngemiphumo yexesha elifutshane kuphela kwaye ingasetyenziswa kwizigulana ezindala ezineengozi eziphezulu zotyando kunye ne-anesthesia.
1) Iimpawu:izigulane ezikwiminyaka ephakathi kunye nezikhulileyo (ezingaphezulu kweminyaka engama-40 ubudala); abo bangakwaziyo ukunyamezela i-endoscopic balloon dilation (PD) okanye unyango lotyando; abo bane-PD ezininzi okanye iziphumo zonyango ezingezizo zonyango lotyando; abo bane-esophageal perforation ngexesha lonyango lwe-PD Kwabo banengozi ephezulu, ingasetyenziswa kunye ne-PD; ingasetyenziswa njengotshintsho kutyando okanye unyango lwe-PD.
(2) Izithintelo:Akukhuthazwa ukuba kusetyenziswe unyango lokuqala lwe-AC kwizigulane eziselula (≤ezineminyaka engama-40 ubudala).
03 Ukwanda kweBhaluni ye-Endoscopic (PD)
Ukwanda kweebhaluni kunemiphumo ethile kwi-AC, kodwa kufuna unyango oluninzi kwaye kunomngcipheko weengxaki ezinkulu.
(1) Iimpawu:Izigulana ze-AC ezingenayo ingxaki yentliziyo nemiphunga, ukungasebenzi kakuhle kokujikeleza kwegazi, njl.njl.; amadoda angaphezu kweminyaka engama-50 ubudala kunye nabafazi abangaphezu kweminyaka engama-35 ubudala; izigulana ezingaphumelelanga utyando. Ingasetyenziswa njengendlela yokuqala yonyango olukhethiweyo.
(2) Izithintelo:Ukungasebenzi kakuhle kwentliziyo nemiphunga, ukungasebenzi kakuhle kokugaya igazi kunye nomngcipheko omkhulu wokugqobhoka komphimbo.
04 I-Peroscopic Endoscopic Myotomy (IMBONGO)
Kwiminyaka yakutshanje, ngokusetyenziswa okukhulu kwe-peroral endoscopic myotomy (POEM), izinga lempumelelo yonyango lwe-AC liye landa kakhulu.Unyango lwe-POEM lwe-AC luhambelana kakhulu nengcamango "yotyando oluncinci kakhulu", oko kukuthi, kuphela izilonda ezisuswayo/ezisuswayo ngexesha lenkqubo yonyango, kwaye amalungu omzimba awasuswa.Ukuthembeka nokusebenza kwesakhiwo somzimba kuyagcinwa, kwaye umgangatho wobomi besigulana emva kotyando awuchaphazeleki. Ukuvela kwe-POEM kwenze unyango lwe-AC lwaba yingozi kakhulu.
Umfanekiso: Amanyathelo otyando lwe-POEM
Ukusebenza kakuhle kwexesha eliphakathi nelide kwe-POEM kunyango lwe-AC kuhambelana noko kwenziwa nge-laparoscopic Heller myotomy (LHM)ingasetyenziswa njengonyango lokuqala.Ezinye izigulana zinokuba neempawu ze-reflux ze-gastroesophageal emva kotyando lwe-POEM
(1) Iimpawu ezicacileyo:I-AC engenakho ukunamathela okunzulu kwe-submucosal, ukuphazamiseka kokuphuma kwesisu kunye ne-diverticulum enkulu.
(2) Iimpawu ezinxulumene noko:Ukusasazeka kwe-esophageal spasm, i-nutcracker esophagus kunye nezinye izifo ze-esophageal motility, izigulane ezine-POEM okanye utyando lwe-Heller olungaphumelelanga, kunye ne-AC ene-submucosal adhesions ethile ye-esophageal.
(3) Izithintelo:Izigulane ezinengxaki enkulu yokungasebenzi kakuhle kwemithambo yegazi, izifo zentliziyo nemiphunga, imeko embi ngokubanzi, njl.njl. ezingakwaziyo ukunyamezela utyando.
05 I-Laparoscopic Heller Myotomy (LHM)
I-LHM iyasebenza kakuhle ixesha elide ekunyangeni i-AC, kwaye ngokusisiseko ithatyathelwe indawo yi-POEM kwiindawo apho iimeko zivuma khona.
06 Utyando lwe-Esophagectomy
Ukuba i-AC idityaniswe ne-lower esophageal scar stenosis, ii-tumor, njl.njl., utyando lwe-esophagectomy lunokucingelwa.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, umgibe we-polyp, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibhrashi ze-cytology, ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlweninjl. ezisetyenziswa kakhulu kwiI-EMR, I-ESD,I-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha leposi: Julayi-09-2024